Provider Demographics
NPI:1073890844
Name:COMMUNITY HEALTH AND WELLNESS CENTER OF GREATER TORRINGTON
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AND WELLNESS CENTER OF GREATER TORRINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-379-2423
Mailing Address - Street 1:469 MIGEON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4643
Mailing Address - Country:US
Mailing Address - Phone:860-489-0931
Mailing Address - Fax:860-489-3325
Practice Address - Street 1:469 MIGEON AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4643
Practice Address - Country:US
Practice Address - Phone:860-489-0931
Practice Address - Fax:860-489-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007606261QD0000X, 261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal